Provider Demographics
NPI:1972790830
Name:FLECK, JULIE A (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:FLECK
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0683
Mailing Address - Country:US
Mailing Address - Phone:406-885-4074
Mailing Address - Fax:
Practice Address - Street 1:17437 COLD CREEK LN
Practice Address - Street 2:
Practice Address - City:ST. IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-0683
Practice Address - Country:US
Practice Address - Phone:406-885-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-64333101YA0400X
MTBBH-LMFT-LIC-38855106H00000X
MTBBH-LCSW-LIC-3041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000502294Medicaid